Provider Demographics
NPI:1972940732
Name:O'BRIEN, ROBERT BRANDON (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRANDON
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3432 MERCER UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-4902
Mailing Address - Country:US
Mailing Address - Phone:478-755-8366
Mailing Address - Fax:
Practice Address - Street 1:3432 MERCER UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-4902
Practice Address - Country:US
Practice Address - Phone:478-755-8366
Practice Address - Fax:478-755-8399
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014588122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist